What are the options for right-to-die campaigners?

This week two severely paralysed men, Paul Lamb and another known only as Martin, received the verdicts in their right-to-die challenges at the UK's Court of Appeal. The family of the late Tony Nicholson were also in court, appealing the 2012 decision that he did not have the right to ask a doctor to end his life. New Scientist examines the issue of euthanasia and some of its ethics in more detail.

First of all, how are euthanasia and assisted suicide defined?

Euthanasia means "good death" in Greek. It can be subdivided into several categories.

Active euthanasia occurs when someone ends another person's life to relieve their suffering, for example, by injecting them with lethal drugs. Passive euthanasia is when something keeping a person alive is withdrawn or withheld, such as food and water or turning off a life-support machine. If the person concerned is able to give their consent, this is known as voluntary euthanasia.

In non-voluntary euthanasia, a person is unable to give consent, perhaps because they are too young or in a minimally conscious state. Involuntary euthanasia occurs when someone able to give consent is killed against their will, but this is almost always classified as murder. The legal and moral issues surrounding these two forms are usually more clear-cut than for voluntary euthanasia.

Complicating matters further is assisted suicide. This is when a person carries out their own suicide, helped by someone else. An example of this would be handing a person lethal sedatives that they then take.

What is currently allowed under UK law?

Passive euthanasia is legal, active euthanasia is not. "It's legal to withdraw food and water from someone and let them starve or dehydrate, but illegal to actually administer anything that actively kills them," says Richy Thompson of the British Humanist Association. Assisting a suicide is also illegal.

How does this affect Paul Lamb?

Lamb, who was paralysed in car crash in 1990, could refuse food and water and his subsequent death would leave his family in the clear. This was what Nicholson did in 2012 after he lost a High Court case to allow doctors to end his life. But such a drawn-out death is obviously unattractive.

Lamb wanted the court to rule that any medical professional who helped him end his life would not be charged with murder. Yesterday the Court of Appeal rejected this challenge, saying that Parliament, not High Court judges, should decide whether or not to change the law on euthanasia. Lamb now has the right to appeal.

What does Martin want?

Like Nicholson, Martin suffers from locked-in syndrome, which means his mind functions but his body is completely immobile. Martin sought to clarify whether a healthcare professional would be prosecuted if they took him abroad to end his life. His family have said they don't want any involvement.

Currently the laws for healthcare professionals travelling to countries where assisted suicide is legal are ambiguous, and yesterday the High Court agreed that they needed clarification.

Martin's case is similar to that of Debbie Purdy, who has multiple sclerosis and whose 2009 case forced a clarification of the laws for family members who took their relatives abroad to end their lives via assisted suicide. To date, no one who has taken a relative to die abroad has been prosecuted.

What is the law in other countries?

Active voluntary euthanasia is legal under strict guidelines in Belgium, the Netherlands and Luxembourg, but only for residents of those countries. Assisted suicide is legal in Switzerland and in the US states of Oregon, Washington and Vermont.

Why can't Martin go to Dignitas, the Swiss group that helps people carry out assisted suicide?

Martin is still able to swallow so in theory he could visit Dignitas, as he would be able to take the last step that leads to his death. This means the act is classed as assisted suicide rather than active euthanasia, which not legal in Switzerland. A paralysed person who couldn't swallow could not be treated at Dignitas. But existing UK laws mean any healthcare professional who accompanies Martin to Switzerland could potentially be prosecuted.

What is next for Lamb?

Lamb has already been granted the right of appeal in the UK Supreme Court. He has a further option, too, should he be unsuccessful. "It is possible for him to go to the European Court of Human Rights to fight his case," says Jonathan Robinson of Bindmans LLP, the law firm assisting him. What might happen if that tactic also fails is uncertain.

What are the arguments for and against euthanasia and assisted suicide?

Organisations such as the British Humanist Association argue that a person's life is theirs to do with as they wish, and that those such as Paul Lamb who are incapable of taking their own lives still deserve a dignified death.

"Patients should be able to choose from a variety of solutions to end their suffering," says Silvan Luley of Dignitas. "Most importantly, patients should be able to discuss all options with their physicians, and physicians should be trained to explain all options in a balanced manner."

Opponents of a change in the law, such as the group Care Not Killing, argue that legalising active euthanasia makes vulnerable groups even more vulnerable, and that safeguards are liable to slip.

"The current law exists to protect the vulnerable and those without a voice," says Andrew Fergusson of Care Not Killing. "[This includes] disabled people, terminally ill people and elderly people: [those who] might otherwise feel pressured into ending their lives."

If you would like to reuse any content from New Scientist, either in print or online, please contact the syndication department first for permission. New Scientist does not own rights to photos, but there are a variety of licensing options available for use of articles and graphics we own the copyright to.

Paul Lamb, and Jane and Lauren Nicklinson, appealing at the High Court over the right to die (Image: Mark Thomas/Rex)